It is exciting to be authoring an article about Telehealth Advances and their relationship to the respiratory profession. A few short years ago, telehealth and respiratory were not conceptually in the same playing field. Those who might have seen the future would have chuckled and thought, “That could never happen!” Fast forward, and circumstances have brought the two together. As a result, the respiratory profession can grow and make a continued significant contribution to patient care. RTs using telehealth can wield a powerful new tool in our “RT Tool Kit.”
Before COVID-19, telehealth in the US was starting to increase; however looking at data collected by Definitive Healthcare in 2019 (Telehealth Adaption in the US: 2020 Trends, 2020), only about 33% of inpatient hospitals and 45% of outpatient facilities offered telehealth services. As of June 2020, about 75% of U.S. hospitals are using telehealth, a 42% increase since 2019. In 2021, April showed the third straight month of declining telehealth use as noted by the FAIR Health’s Monthly Telehealth Regional Tracker. Overall telehealth claim lines declined nationally 12.5 percent of all medical claim lines. (This data represents the privately insured population, excluding Medicare and Medicaid).1 This decline is thought to be attributed to the return of in person healthcare visits with the subsequent COVID-19 restriction changes and the increase in the number of vaccinated people.
Necessity has created a significant increase in the adoption of telehealth. Before the Public Health Emergency (PHE), some patients claimed “they didn’t know how to use technology” as to why there were not interested in telehealth. Since then, some of these same patients have conquered their tech dilemma with the aid of family and friends because they didn’t want outsider health care providers in their homes during the PHE.
- According to mHealth Intelligence, a mobile health care and telehealth news and resource organization, in a poll of the general population, 90% of patients want digital health connections with their doctors/providers.
- The PHE is driving health care organizations (HCOs) to invest in technology at a time when projected losses for 2020 is up to $323.1 billion, according to the American Hospital Association.1 HCOs, because of the PHE, have had to offer virtual care along with other protocols to keep patient-staff interactions safe from unnecessary COVID-19 exposures. In addition, the HCOs’ pivot in providing telehealth options has shown positive consumer satisfaction reinforcing the need to invest in technology despite the financial challenges in the industry.2
- Telehealth growth in the ICU has also occurred during the PHE. Although survey results from the Society for Critical Care Medicine (SCCM) results from more than 4,800 critical care providers, show that only 29.5% said their ICU is equipped with a telemedicine system that could manage COVID patients.3 Those responding to the survey identified the telemedicine equipped shortfall consisted of not having the actual hardware and software systems in place to provide telehealth in their ICU rooms. In addition to the equipment having the staffing via internal existing staff and/or contracted outsourced services added to this shortfall. Creating virtual telehealth ICUs maximizes resources in the system by converting non-critical care beds into ICU beds, improving hospital critical care capacity, mitigating exposure and conserving PPE, and remote monitoring of additional patients.
- In an unrelated PHE study, “In Hospital Telehealth Supports Care of the Neonatal Patient in Strict Isolation,”4 the researchers used a telehealth system in each of the NICU rooms. The primary care nurse was at the bedside, and other health care providers would virtually visit at the bedside as much as possible. This added patient feature was found to successfully provide the same level of care to support the NICU patients. In addition, it mitigated potential exposures and conserved PPE that was in short supply because of the PHE.
- In the outpatient side of patient care, ambulatory contacts before and during COVID-19 are revealing showing a shift away from in to virtual person visits. A cohort study of 30,568,010 US individuals showed ambulatory contacts decreased between 2019 and 2020 from March to June. At the same time, telehealth use increased from 0.3% in 2019 to 23.6% in 2020.5
- The Home Medical Equipment (HME) industry has also seen a growth in virtual home visits due to the PHE. Patients not wanting health care providers coming into their homes for equipment set up instruction on using a PAP device opened the door for the HME to conduct virtual video or telephonic interaction with the patient. The temporary lightening of HIPAA enforcements during the PHE provided HMEs more access to readily available video technology without investing in a telehealth system. “ However, many HMEs are planning to continue using telehealth for PAP setups and other device instruction and monitoring.2
Telehealth and Telerespiratory will continue to advance and expand as a means of providing health care. However, we need to address the remaining barriers to allow the proliferation to continue. Rural areas are at a disadvantage because of the lack of reliable broadband internet connectivity. Free market initiatives and efforts through legislation continue to expand broadband access, but much more work needs to be done. Access and use of smart devices continue to improve. Smartphone ownership in the U.S. is most common in the younger age groups; 95% of adults aged 18-49 own a smartphone. Smartphone ownership amongst adults 65 and older is only 61%.3 Having telehealth applications that are simple for the end-user is essential for success in this demographic. For example, wherever possible, the patient or consumer should be able to access the virtual visit without having to download an app. The technology we use in our company sends a simple SMS text or email to the patient. They only need to open the message and click “accept.” Then the device can access and use the microphone and camera. At this point, they are connected in a HIPAA compliant video chat. Removing as many barriers as possible will only enhance success.
Tech trends will continue to advance in finding new ways to assist with monitoring and improving the health of patients and consumers. Health care in the home is the future in my opinion and looking for ways to see this occur is all our responsibilities. My personal suggestion is to embrace technology for the positive impact it can make.
American Hospital Association. June 2020. Hospitals and health systems continue to face unprecedented financial challenges due to COVID-19 [financial impact report]. https://aha.org/system/files/media/file/2020/06/aha-covid19-financial-impact-report.pdf.
Bloomberg.com. 2020. Telehealth patient satisfaction surges during pandemic but barriers to access persist, J.D. Power finds [press release]. Oct. 1. https://bloomberg.com/press-releases/2020-10-01/telehealth-patient-satisfaction-surges-during-pandemic-but-barriers-to-access-persist-j-d-power-finds.
SCCM ICU Readiness Assessment https://sccm.org/getattachment/Blog/April-2020/ICU-Readiness-Assessment-We-Are-Not-Prepared-for/COVID-19-Readiness-Assessment-Survey-SCCM.pd?lang=en-US.
AmJ Perinatol 2020Jun:37(8) 857-860.
JAMA NetworkOpen, 2021;4(3):e212618. Doi:10.1001/jama at work open.2021.2618.
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